Venous thromboembolism

Venous thrombotic disease is a serious concern for critically ill children hospitalized in the intensive care and cardiac intensive care units. Children with both innate and acquired conditions, including cardiac disease, a central venous catheter, immobility, a postoperative state, malignancy, an infectious or inflammatory state, traumatic injuries, or a disturbance of the coagulation pathway, may suffer from a venous thromboembolism during their hospitalization. As children suffer from both acute and chronic morbidity as well as a heightened risk of death following venous thromboembolism, it is essential that clinicians consider the latter as a possible complication during an intensive care admission. Treatment of venous thromboembolism in the acute period includes the use of anticoagulants, thrombolytic agents, mechanical and surgical thrombectomy, vena caval filters, and, in rare cases, observation and supportive care alone. In the child with congenital or acquired cardiac disease, the modality of treatment is dependent upon many considerations. Among these are the severity and location of the venous thromboembolism, the anatomy and physiology of the child, as well as the surgical and intervention history, and the clinical stability of the patient. Chronic therapy is considered to prevent recurrent events and embolization from residual thrombus. Although prevention strategies are imperative to decrease the incidence of venous thromboembolism, there is no consensus in the pediatric literature to inform optimal thromboprophylaxis guidelines. In general, thromboprophylaxis is prescribed for children with cardiac disease requiring palliative or corrective surgery, endovascular stents, bioprosthetic or mechanical valves, cardiac catheterization, or cardiac transplant as they are at greatest risk of developing venous thromboembolism. Further inquiry must be undertaken to determine the safety and benefit of thromboprophylaxis for other critically ill children in the intensive care with multiple risk factors.